Facility Characteristics and the Risk of Developing Pressure Ulcer in U.S. Nursing Homes

Prevention programs targeting nursing home-acquired pressure ulcers had limited success due to the complexities in several individual- and facility-level factors. We examined the impact of facility characteristics on nursing home-acquired pressure ulcers after controlling for individual risk factors. We studied 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used a multinomial logistic regression model to predict risk-adjusted probabilities of pressure ulcers with four stages. Among the 1,313 residents developed pressure ulcers, 326, 675, 133 and 179 were at stage I, II, III and IV accordingly. Ulcer diagnosis at admission substantially increased the odds of developing stage IV ulcers. Higher average ADLs per person, using bedrail and needing assistance in bed mobility were each associated with greater odds of developing ulcers at all stages. Medicaid coverage increased the odds, especially at more advanced stages; while insured by Medicare predicted slightly smaller odds of stage IV ulcers. Facilities with higher percentage of Medicaid or Medicare beneficiaries predicted greater odds of stage IV ulcers (OR 2.14, 95%CI[2.09,2.18] and OR 1.56, 95%CI[1.53,1.59]). A director of nursing on board reduced the odds of ulcers at stages I to III. Facilities offering clusters of beds for Alzheimer's disease or rehabilitation as well as special care programs for end-of-life, behavior problem, or skin wounds all reduced the odds of stage IV ulcers. Policy efforts to enhance Medicaid payment approaches and levels, as well as to provide special care programs will likely reduce nursing home acquired ulcers.